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COVID-19 has added an additional level of complexity for patients with rheumatic disease who wish to become pregnant.
Pregnant women with rheumatic disease who developed COVID-19 had promising outcomes, offering cautious optimism for this patient population, according to a study published in The Journal of Rheumatology.1
“Rheumatic diseases commonly occur in reproductive-aged women. The impact of pregnancy on the underlying rheumatic disease, the rheumatic disease impact on pregnancy, and the limitations in the use of anti-rheumatic medications can make disease management challenging,” investigators explained. “With the global outbreak of the novel COVID-19, an additional level of complexity has been added for women with rheumatic diseases who wish to become pregnant.”
Health care providers have been collecting data from patients with rheumatic disease diagnosed with COVID-19 since March 24, 2020. Information is then entered into the COVID-19 Global Rheumatology Alliance (C19-GRA) provider REDCap survey. Data includes patient age, sex, race and ethnicity, country, city, and clinic. It also provides details of disease activity, comorbidities, current medication usage, and COVID-19-related information, such as symptoms, treatments, outcomes, and diagnosis date.
This study analyzes pregnant patients between March 24, 2020 and January 14, 2021 and includes 2 follow-up REDCap surveys performed on July 1, 2020 and January 15, 2021. Additional details requested were gravida, gestational age at COVID-19 diagnosis, medication usage through COVID-19 illness, and obstetric outcomes. Data was then compared with non-pregnant women from the C19-GRA registry.
A total of 39 patients were included in this study, with a median age of 33 years. The most common race/ethnicity was White (33%), followed by Latin American/Hispanic (23%), Arab or Middle East (23%), South or East Asian (15%), and Black (5%). While comorbidities were infrequent, they included pre-pregnancy hypertension (n = 3), morbid obesity (n = 2), obesity (n = 1), pregestational diabetes mellitus (n = 1), and psoriasis (n = 1).
Mean gestation at COVID-19 diagnosis was 23.3 weeks, with 3 developing COVID-19 in the first trimester, 13 in the second trimester, and 6 in the third trimester. Rheumatic diseases included rheumatoid arthritis (RA) (n = 9), systemic lupus erythematosus (SLE) (n = 9), psoriatic/other inflammatory arthritis (PsA) (n = 8), and anti-phospholipid antibody syndrome (n = 6). Most patients had minimal or low disease activity (n = 18) or were in remission (n = 13).
Roughly a quarter (n = 10/39) were hospitalized due to COVID-19 illness, but only 2 required supplemental oxygen. No women delivered due to COVID-19 infection and no patients died. The most common symptoms included cough (n = 24), fever (n = 21), headache (n = 12), anosmia (n = 11), shortness of breath (n = 11), and myalgia (n = 11), although 3 patients were asymptomatic. Of the 39 patients, 82% (n = 32) did not require any specific medication treatment during their illness.
The small number of patients and incomplete data limits the study. Additionally, as information was submitted voluntarily, there is a chance that selection bias regarding complex and active disease as well as more severe COVID-19 cases may have impacted results. Lastly, favorable outcomes may have had more to do with the fact that patients were young, had few co-morbidities, and were on lower glucocorticoid doses.
“Pregnancy and COVID-19 outcomes in pregnant patients with systemic rheumatic disease were relatively benign in this patient series,” investigators concluded. “However, data on all pregnancy outcomes and whether there were any cases of vertical transmission to infants is not available. Additional cases with greater granularity of data regarding pregnancy and fetal outcomes in the rheumatic disease population will greatly enhance our knowledge in this area.”
Bermas BL, Gianfrancesco M, Tanner HL, et al. COVID-19 in women with rheumatic disease who are pregnant: Data from the COVID-19 Global Rheumatology Alliance [published online ahead of print, 2021 Sep 1]. J Rheumatol. 2021;jrheum.210480. doi:10.3899/jrheum.210480